MEDICARE: AGENCY FOR TOXIC SUBSTANCE AND DISEASE REGISTRY (ATSDR)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency	25MA05120800	NJ

General Provider Information

NPI Number	:	1396058921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGENCY FOR TOXIC SUBSTANCE AND DISEASE REGISTRY (ATSDR)

Provider Business Mailing Address
First Line	:	1600 CLIFTON RD NE
Second Line	:	MS: F-59
City	:	ATLANTA
State	:	GA
Zip	:	30329-4018
Country	:	US
Telephone Number	:	770-488-0744
Fax Number	:	770-488-1528

Provider Business Practice Location Address
First Line	:	4770 BUFORD HWY
Second Line	:	MS: F-59
City	:	ATLANTA
State	:	GA
Zip	:	30341-3717
Country	:	US
Telephone Number	:	770-488-0744
Fax Number	:	770-488-1528

Authorized Official
Title or Position	:	DIRECTOR OF ATSDR
Name	:	DR. HENRY FALK
Credential	:	M.D.,
Telephone Number	:	18884228737

Provider Enumeration Date	:	07/25/2010
Last Update Date	:	07/25/2010

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